ACP issues pressure ulcer prevention, treatment guidelines

Guidelines on risk assessment, prevention, and treatment of pressure ulcers were issued by ACP this week.

The guidelines, published in the March 3 Annals of Internal Medicine, are based on evidence reviews, which were published as a supplement. The guideline on risk assessment and prevention of pressure ulcers includes 3 recommendations:

• ACP recommends that clinicians should perform an assessment to identify patients who are at risk of developing pressure ulcers (weak recommendation, low-quality evidence).
• ACP recommends that clinicians should choose an advanced static mattress or advanced static overlay in patients who are at an increased risk of developing pressure ulcers (strong recommendation, moderate-quality evidence).
• ACP recommends against using alternating-air mattresses or alternating-air overlays in patients who are at increased risk of developing pressure ulcers (weak recommendation, moderate-quality evidence).

The authors of the guideline noted that although risk assessment tools can be helpful in some cases, “the current evidence does not conclusively show a difference between clinical judgment and risk assessment scales in reducing pressure ulcer incidence.” As for preventive interventions, the evidence supported the benefits of advanced static mattresses or overlays (although no specific brand) over standard mattresses but found no clear additional benefit from alternating-air beds and overlays, which are significantly higher cost.

The guideline on treatment of pressure ulcers also provided 3 recommendations:

• ACP recommends that clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound size (weak recommendation, low-quality evidence).
• ACP recommends that clinicians use hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size (weak recommendation, low-quality evidence).
• ACP recommends that clinicians use electrical stimulation as adjunctive therapy in patients with pressure ulcers to accelerate wound healing (weak recommendation, moderate-quality evidence).

The evidence was insufficient to recommend an optimal dose or form of protein, the guideline authors noted. There was also insufficient evidence on the effectiveness of alternating-air chair cushions, 3-dimensional polyester overlays versus gel overlays, zinc supplementation, L-carnosine supplementation, other wound dressings, topical phenytoin, maggot therapy, other biological agents, surgical techniques, or hydrotherapy.

Practicing physicians will have to make treatment decisions in these areas despite the lack of evidence and thus might have to also consult other, opinion-based guidelines, according to an accompanying editorial. There is a dire need for additional research in this field, the editorialist concluded.